Kentucky - Respite Care Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

Kentucky's Cabinet for Health and Family Services (CHFS) authorizes Respite Care Services across six 1915(c) Medicaid waivers, including the Home and Community Based (HCB) and Michelle P. waivers, to provide temporary relief for unpaid primary caregivers. Providers must secure approval through the Medicaid Partner Portal Application (MPPA) and credential with the state's Managed Care Organizations (MCOs), while facility-based delivery requires a distinct Adult Day Care or residential license from the Office of Inspector General (OIG) before Medicaid enrollment is permitted.

Under a rule effective July 1, 2024, Legally Responsible Individuals (LRIs) can now be paid for extraordinary care under Participant Directed Services (PDS), expanding the pool of eligible respite workers. Agencies delivering traditional provider-managed respite must maintain compliance with 907 KAR 7:015, ensuring staff pass background checks and complete waiver-specific training before billing against a participant's approved Person-Centered Service Plan.

1. Service Definition and Scope

In Kentucky, Respite Care Services provide temporary, substitute care for a Medicaid waiver participant when their usual unpaid caregiver is unavailable, needs relief, or experiences an emergency. The service ensures the participant's health, safety, and supervision are maintained without interruption.

Services can be delivered in the participant's home, a provider's home, or a licensed facility, depending on the specific waiver's approved settings. Respite cannot replace full-time residential care and must be explicitly documented in the participant's Person-Centered Service Plan (PCSP).

• In-Home Respite: Delivered in the participant's primary residence to support aging in place.
• Facility-Based Respite: Delivered in licensed Adult Day Health Care centers or approved residential settings.
• Participant Directed Services (PDS): Allows participants to hire their own respite workers, including certain relatives.
• Covered Tasks: Includes supervision, assistance with Activities of Daily Living (ADLs), and medication reminders.
• Waiver Variations: Scope and maximum allowable hours vary between the HCB, SCL, MPW, ABI, and MIIW programs.

2. Regulatory and Oversight Agencies

The Kentucky Cabinet for Health and Family Services (CHFS) is the umbrella agency overseeing Medicaid and HCBS waivers. Within CHFS, multiple departments handle specific regulatory, enrollment, and quality assurance functions for respite providers.

Providers must interact with the Medicaid agency for billing and enrollment, the aging department for waiver operations, and the inspector general for any facility-based licensure.

• Cabinet for Health and Family Services (CHFS): The primary state agency overseeing health programs (https://www.chfs.ky.gov).
• Department for Medicaid Services (DMS): Administers Medicaid funding, waiver policy, and provider enrollment (https://chfs.ky.gov/agencies/dms).
• Department for Aging and Independent Living (DAIL): Monitors service delivery and operates the HCB and Michelle P. waivers (https://chfs.ky.gov/agencies/dail).
• Office of Inspector General (OIG): Licenses facility-based respite settings such as Adult Day Care centers (https://chfs.ky.gov/agencies/os/oig).
• Medicaid Partner Portal Application (MPPA): The official system for provider enrollment (https://medicaidsystems.ky.gov).

3. Gatekeeping Prerequisites: Who Can Even Apply

Kentucky does not require a Certificate of Need (CON) for in-home respite care agencies, nor are there closed enrollment windows for standard HCBS waiver providers. However, structural prerequisites dictate how and where a provider can operate.

If a provider intends to offer facility-based respite, they are structurally blocked from Medicaid enrollment until they secure the underlying facility license from the OIG. Additionally, traditional agency providers must successfully contract with Kentucky's Medicaid Managed Care Organizations (MCOs) to receive authorizations and payments.

• Facility Licensure Prerequisite: Adult Day or residential facilities must obtain an OIG license before applying for Medicaid respite enrollment.
• MCO Contracting: Agencies must credential and contract with Kentucky's Medicaid MCOs to serve managed care enrollees.
• PDS Financial Management Agent (FMA): Independent PDS workers must process enrollment and payroll through the state's designated FMA.
• Waiver Waitlists: The SCL, MPW, and ABI waivers frequently have waitlists, limiting the immediate participant pool for new providers.
• Business Registration: Applicants must be registered with the Kentucky Secretary of State and hold an active EIN and NPI.

4. Licensure and Certification Requirements

Kentucky does not issue a standalone "Respite Care Agency" license for in-home providers. Instead, in-home agencies are certified through the Medicaid provider enrollment process by demonstrating compliance with waiver regulations such as 907 KAR 7:015.

Providers offering respite outside the participant's home must hold the appropriate facility license. All providers must maintain comprehensive policy manuals covering participant rights, emergency protocols, and HIPAA compliance.

• In-Home Certification: Achieved via MPPA enrollment and adherence to 907 KAR 7:015 standards.
• Adult Day Licensure: Required for daytime facility-based respite, issued by the CHFS OIG.
• Insurance Requirements: Agencies must maintain general liability and, if applicable, property insurance.
• Policy Manual: Must include intake forms, grievance procedures, and incident reporting protocols.
• Participant Rights: Providers must document that participants are informed of their rights and consent to care.

5. Medicaid Provider Enrollment

All prospective respite providers must enroll through the Medicaid Partner Portal Application (MPPA). The process requires submitting business credentials, ownership disclosures, and proof of required policies.

Once approved by DMS, the provider is issued a Medicaid ID but must still complete credentialing with individual MCOs to bill for services rendered to managed care participants.

• MPPA Portal: All applications must be submitted electronically via https://medicaidsystems.ky.gov.
• Provider Type: Applicants must select the specific HCBS waiver provider type corresponding to the waivers they intend to serve.
• Application Fee: Providers must pay the federal Medicaid application fee unless enrolled in Medicare or exempt.
• Ownership Disclosure: Detailed reporting of individuals with 5% or more ownership or controlling interest.
• MCO Credentialing: A secondary, mandatory step taking 60-90 days after DMS approval.

6. Staffing, Training and Background Checks

Direct support workers providing respite must meet baseline qualifications established by DAIL and DMS. This includes passing comprehensive background checks before having direct contact with participants.

Effective July 1, 2024, Kentucky implemented a rule allowing Legally Responsible Individuals (LRIs) to be paid for respite under PDS if they provide documented extraordinary or specialized care.

• Background Checks: Mandatory state police and abuse registry clearances for all direct care staff.
• Basic Certifications: Staff must hold current CPR and First Aid certifications.
• LRI Exception: Spouses/parents can be paid under PDS only for extraordinary care, effective July 1, 2024.
• Relative Hiring: Adult children and non-LRI relatives can be hired under PDS without the extraordinary care restriction.
• Waiver-Specific Training: Staff must complete training on ADL support, HIPAA, and person-centered care as dictated by the specific waiver.

7. Documentation, Policies and Records

Strict recordkeeping is required to justify Medicaid reimbursement and survive state audits. Every hour of respite billed must trace back to the participant's approved Person-Centered Service Plan (PCSP).

Providers must maintain daily logs detailing the start and end times of service, the specific tasks performed, and the signature of the worker and participant or caregiver.

• PCSP Alignment: Services must be explicitly authorized in the participant's care plan.
• Timesheets: Exact in/out times must be recorded and verified.
• Service Logs: Documentation of ADL assistance, medication reminders, and behavioral supports provided during the shift.
• Incident Reporting: Critical incidents must be reported to DAIL and the MCO within specified regulatory timeframes.
• LRI Documentation: Extraordinary care provided by an LRI must be heavily documented to justify payment.

8. Billing, Rates and Claims

Respite care is billed using specific HCPCS codes determined by the waiver and the setting (e.g., 15-minute increments vs. per diem). Rates are capped by Kentucky's HCBS waiver fee schedules.

Traditional agencies bill the participant's MCO directly, while PDS workers submit timesheets to the Financial Management Agent (FMA), which processes payroll and withholds taxes.

• HCPCS Codes: Billing relies on standard codes (e.g., S5150 or S5151) as defined in the waiver manual.
• Rate Caps: Maximum allowable rates are published on the DMS fee schedule.
• MCO Claims: Agencies submit claims through the respective MCO's clearinghouse.
• PDS Payroll: The FMA handles employer taxes, FICA, and timesheet processing for self-directed workers.
• Prior Authorization: No claims will be paid without an active prior authorization from the MCO or DAIL.

9. Approval Sequence and Timeline

Becoming a fully operational respite provider in Kentucky is a multi-phase process. Establishing the business entity and developing compliant policy manuals typically takes 1-2 months.

State Medicaid enrollment and subsequent MCO credentialing add significant time, meaning providers should plan for a 4-6 month runway before they can bill for their first client.

• Phase 1: Business formation, NPI acquisition, and policy development (1-2 months).
• Phase 2: Facility licensure via OIG (if applicable, timeline varies based on inspections).
• Phase 3: MPPA Medicaid enrollment submission and DMS review (30-60 days).
• Phase 4: MCO credentialing and contracting (60-90 days).
• Phase 5: Staff hiring, background checks, and service launch.

10. Common Denials and Survey Findings

Applications and claims are frequently delayed or denied due to administrative errors or failure to follow waiver-specific rules. Incomplete ownership disclosures in the MPPA are a primary cause of enrollment rejection.

During audits, DAIL and MCOs frequently recoup funds if respite hours exceed the PCSP authorization or if staff background checks were not completed prior to the first date of service.

• MPPA Rejections: Caused by missing EIN/NPI verification or incomplete ownership disclosures.
• Background Check Gaps: Staff providing care before state police clearances are fully returned.
• Overbilling: Claiming more respite hours than authorized in the participant's PCSP.
• LRI Rule Violations: Paying a spouse for routine care without the required extraordinary care documentation.
• Missing Signatures: Timesheets lacking the participant or primary caregiver's verification signature.

11. Key Contacts and Resources

Navigating Kentucky's HCBS landscape requires utilizing the state's official portals and contacting the correct divisions for policy clarification. The MPPA help desk is the primary contact for enrollment technical issues.

Providers should regularly check the DMS and DAIL websites for waiver amendments, updated fee schedules, and provider bulletins.

• Medicaid Partner Portal Application (MPPA): https://medicaidsystems.ky.gov
• CHFS Department for Medicaid Services: https://chfs.ky.gov/agencies/dms
• CHFS Department for Aging and Independent Living: https://chfs.ky.gov/agencies/dail
• CHFS Office of Inspector General: https://chfs.ky.gov/agencies/os/oig
• kynect Benefits Portal: https://kynect.ky.gov

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